The rise in measles in Canada and Ontario: a story of public health and beliefs

Ontario’s government has approved seven weeks of optional, opt-out vaccination for 6- and 7-year-olds starting this year. The outbreak of whooping cough in kindergarten classes — a disease with a vaccine-preventable cause — is, reportedly, the largest in Ontario’s history. Between July and September, a total of 664 cases were reported in Ontario, 92 of which were in kindergarten classes where the vaccine is not required to receive an education.

With 19,000 kindergarten students across Ontario, the numbers are staggering. Determining what the status of these schools is, what the school or school district is doing, and whether the virus spreading in schools can be kept at bay is a process that, though tricky, cannot be avoided.

Prof. Johanna DiMartino, an infectious disease expert, explains that given the greater range of temperatures and humidity, larger jurisdictions may already know about as many as 20,000 whooping cough cases in their region. Unlike in October, whooping cough thrives during cooler weather, and in climate with milder winters.

In response to a decision by the Ministry of Health, the media and Ontario politicians have picked up the tone and demands of a story. More than a community, the issue can be viewed through the lens of individual children. Take the actions of a Catholic school — Morristown Catholic Elementary School, in the Toronto suburb of Hamilton. In a strongly worded statement, the school says, “no to vaccination in line with the beliefs of the Catholic faith.”

A new review of research that ran for five years says there is a “strong and consistent” relationship between “vaccine refusal” and “persistent outbreaks of infectious disease” in the U.S. and Ontario, and it has a list of reasons why. The most commonly cited reason for not vaccinating is the belief that it is unnecessary, leading to a perception that anti-vaccination parents are the sole ones doing the choosing.

Other reasons include a belief that they are rare — a plausible belief given that anti-vaccination parents have been in the news — and not necessary — only anecdotal evidence of a dangerous disease, not public data.

A name-and-shame scheme could help parents explain to their children that every virus, a.k.a. virus inoculation, has risk, and that the spread of one disease requires that a single vaccine be given. This method was used successfully in U.S. schools last year, with a mailing, voicemail and email when parents of chronically unvaccinated children failed to immunize against pertussis, diphtheria and whooping cough.

Though the anti-vaccination movement is by no means the sole way of spreading the message, there are tools a parent or concerned student can use to spread the right information. Parenting and education sites on the internet, and communities are also mobilized; research shows that nearly 30,000 readers of an anti-vaccination post on the mother and toddler parenting blog Mommy Mama routinely come to the site to ask for more information.

Parenting will see a rise in whooping cough cases nationwide, but these immunization numbers are real. Whooping cough, pneumococcal and flu vaccinations have been, and will continue to be, a way of protecting the young and protecting older generations.

Prof. DiMartino emphasizes that the fact that someone does not want to vaccinate does not mean they will not get sick.

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